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Sunday, April 29, 2007

I just wanted to put out a primer on what to do when a dental emergency hits. These suggestions are general guidelines, contact your dentist for information specific for your case and any modifications to the suggestions below:

Bitten tongue, cheek, lips, etc:Gently rinse area with cool water or wipe with damp gauze or cloth. Swelling is controlled with a cold pack or crushed ice in a ziplock. If bleeding continues, apply pressure with cool wet gauze or teabag. Take appropriate pain medication.

Bleeding Gums: Normally associated with periodontal (gum) disease. The best way to minimize bleeding is brushing twice a day for two minutes, flossing daily, cleaning your tongue and visiting your dentist for regular checkups. Very rarely, persistent bleeding gums can be a early warning sign for leukemia.

Canker Sores: Keep the area clean by gentle tooth brushing and rinsing with salt water. Healing should occur in about 2 weeks. Avoid acidic, hot and spicy foods and drink. If needed, take pain medications and give us a call for an assessment. Do not apply any pain medication to the area.Fractured or Broken Tooth: Gently rinse area with water (salt water if possible). Control bleeding with a cool wet gauze or teabag (apply pressure only to the bleeding tissues, not the tooth). Do not remove fractured pieces and save all fragments. Take the appropriate pain medication and see your dentist right away.

Gum Boil: Keep the area clean by gentle tooth brushing and rinsing with salt water. If pain and swelling increases in the area then cool compresses and pain medications will help. Do not try to pop the boil. You may need to be put on antibiotics. See us as soon as possible.Knocked out Tooth: Save the tooth or tooth pieces in a balanced saline solution, contact lens solution, milk or water. If bleeding continues, apply pressure with cool wet gauze or teabag. Take appropriate pain medication. Do not clean the area as the tissue fragments will help the healing process if the tooth can be reinserted. Be gentle with the developing clot, no spitting, smoking or use of a straw. You must get to a dentist within 60 minutes to have any real chance of saving the tooth.

Loose Baby Tooth: If the child can wiggle the tooth out...great! Encourage the child to move the tooth in all directions, but do not use large forces. Slow and steady usually wins out. If both the adult tooth and baby tooth are visible then see us for an assessment.Toothache: Avoid the area as much as possible: no biting, or food items in the area, avoid hot and cold drinks. If pain increases and swelling occurs, then a cold compress in the area will help. Pain medications as needed. See your dentist as soon as possible, you will likely have to take antibiotics.

Teething Pains: Freeze or chill some baby carrots and apply them to the area. Ice chips in a ziplock or cloth is also good. Some mild pain relievers and teeth gel (follow the instructions closely, do not overuse) can help.

Wisdom Tooth: Keeps the area as clean as possible with tooth brushing and warm salt water rinses. If the area begins to swell and pain increases, a cool compress and pain medications will help the situation. You may need to be put on antibiotics and the tooth/teeth will likely need to come out. Give us a call immediately

In general, Advil (Motrin/Ibuprofen) 200mg every 4-6 hours should help pain and inflammation. Tylenol (Acetaminophen) 325mg every 4-6 hours is a good secondary alternative. Please review any allergies with your physician/dentist to these medications before using them. We can prescribe higher doses and different pain medications once an assessment of your situation is completed.

Saturday, April 28, 2007

Plunged into Darkness:For want of $1,300 to pay an emergency dental bill, Moses Han went blind.

It was a simple problem to fix – for those with the money or private dental insurance.

But Moses, born in Korea with the name Jae-Bum Han, did not have either. He worked 14-hour days, seven days a week, in his Oakville convenience store, the sole source of income he and his wife, Gloria Joung-Rae Lee, used to raise three young daughters in their nearby townhouse.

Too embarrassed to tell his dentist he didn't have the money, Moses decided to take the pain. When he walked out of a Mississauga dental clinic last October, Moses knew only that the nerves in his back left molar were dying.

What he did not know is that abscesses can develop in dead teeth. Dr. Hazel Stewart, of Toronto Public Health, says these infections can expand swiftly, sometimes creating severe distress within 48 hours.

Left unchecked, infection can spread through the neck, jaw and torso. It can creep upward to the nerves and blood vessels that surround the brain, and the orbital cavities around the eyes.

Friday, April 27, 2007

I am so very proud to announce that we have reached our first anniversary at our current location. I want to thank all the people that have made my first year as a practice owner so rewarding. First, I would like to thank my dear wife and family along with my friends and co-workers at 2233 Hurontario. A special note goes to Jodie Ton, who has done a magnificent job as my assistant/front desk person.

I am pleased to announce that we have added, in our initial year over 135 families to our roster of active patients. Both Jodie and I are very thankful for the support of our patients during the growing phase of our practice and appreciate the great number of referrals...keep it up :)

Yesterday, some of our great staff at both practices went to the Ontario Dental Association convention (at the Metro Convention Centre in Toronto) and we all had a great time there. I attended a nice course on oral surgery and bought a few more instruments to expand our scope and efficiency at extractions and other surgical procedures. Of course, it wouldn't be a day without taking a picture with the Listerine guys.

I actually won a prize at the convention: a great gift certificate from FTD flowers. Thanks to the ODA and everyone involved for making the day very interesting and informative.

(in the picture above, from left to right: Jodie, Deborah, and myself)

Sunday, April 22, 2007

We were proud to be one of the sponsors for the 4UnityProductions fundraiser. Who are they? Here's how they describe themselves:

4UNITY productions is a youth driven media association dedicated to facilitating multimedia-based opportunities [audio, video, new media] for youth [12-24] in Parkdale and across the GTA. 4UNITY productions stresses teamwork, creativity, critical thinking and arts education and is committed to improving the lives of urban youth by enabling the transformation of their often challenging life experiences into positive realities. 4UNITY integrates life and job skill development with urban art forms in an effort to help develop and foster self-esteem, self-worth, creativity and hard skills to youth at no cost.

They are based in Parkdale, which is one of the lower income areas of Toronto. Thanks to the Arts Management students at the University of Toronto and Sonia P. for contacting me for this endevour.

(I found it ironic that the toothbrushes were next to the candy, but if you're going to eat a few sweets, you might as well brush afterwards.)

Friday, April 20, 2007

New guidelines for prevention of infective endocarditis were released by the American Heart Association April 19. The AHA and ADA now recommend that fewer dental patients with heart disease receive antibiotic prophylaxis before dental procedures to prevent the heart infection called infective endocarditis (IE). The guidelines were developed by a group appointed by the AHA that included experts in infectious disease and cardiology and members representing the ADA. The guidelines were endorsed by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society.

After reviewing relevant scientific literature from 1950–2006, the group concluded that bacteremia resulting from daily activities is much more likely to cause IE than bacteremia associated with a dental procedure. In addition, only an extremely small number of IE cases might be prevented by antibiotic prophylaxis, even if prophylaxis is 100% effective. Based on these conclusions, antibiotic prophylaxis is now recommended before dental procedures only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE, such as patients with artificial heart valves, a history of endocarditis, certain serious congenital heart conditions and heart transplant patients who develop a problem with a heart valve.

Sunday, April 15, 2007

Oral Appliance (OA) therapy has been used in patients with primary snoring and mild sleep apnea and has been proven effective. The concept is to position the mandible and tongue anteriorly (forward) to help open the airway. However, long term use has been shown to cause tooth shifting in about 85% of patients with about 41% having a favourable change and 44% unfavourable. Overbite and overjet also tended to decrease.

Saturday, April 14, 2007

I've started the transition to using zirconia abutments and crowns with my implant cases. Why? Two main advantages:

The silver colour of a usual titanium implant abutment (structure underneath the crown) can now be a colour that more resembles the final crown. Allows for better aesthetics. (first image)

The strength of the crowns is incredible (reportedly up to 1200 MPa), especially compared to all-porcelain crowns with very comparable aesthetics. Allows for better durability. (second image)

Thanks to POW Laboratories for the excellent lab work. The crowns can be cemented with a temp cement (yes, the fit is that good!) or a non-expanding permanent cement. The implants that we primarily use are Noble Biocare Replace Select.

Since dentists can recommend the use of Salivart Oral Moisturizer, the Canadian Dental Association is bringing to your attention the following Health Canada advisory about the recall of certain lots of this product because of possible contamination with mould or yeast:www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2007/2007_38_e.html

We don't use Salivart at either of the offices that I work at, but I wanted to put this information out to our general readership.

Researchers in Europe and Israel, funded by the European Union, are working on a tiny drug-dispensing system called IntelliDrug that goes into a person's mouth — with the ultimate goal of getting the parts small enough to fit into a replacement tooth placed in the back like a molar. The device can release a specific amount of medicine at certain intervals, ensuring that the patient gets the proper dosage at the right time.

Patients, on average, follow instructions on taking drugs only half the time, even for people who need them to survive, said Dr. Andy Wolff, an Israeli dentist who initially came up with the concept. Patients often forget or find it too inconvenient to take medicine, especially in the middle of the night. He believes the device will rectify the problem by automating the process.

Wednesday, April 04, 2007

The safety of bisphenol A (BPA) has been called into question in recent media coverage. BPA is a chemical found in many hard plastics and used in resins that line food and beverage cans. Although some believe BPA is an ingredient in dental sealants and composites, it isn’t, although there’s some evidence that some dental sealants and to a lesser extent composites may contribute to low-level BPA exposure, probably through the action of salivary enzymes on a minor ingredient. We see no cause for concern at this time but do look forward to the results of a review of a draft report on BPA safety by an independent NIH panel of endocrinologists, statisticians and biologists. The panel evaluated more than 500 scientific studies and was unable to reach a conclusion so the report isn’t expected to be finalized for at least several weeks. The panel has no regulatory authority, and the findings aren’t binding. We’ve posted a press statement about BPA on ADA.org and will continue to keep the profession informed.

Monday, April 02, 2007

I truly feel that growing a dental practice in a community requires the obvious effort of the dentist and dental staff. However, I've come to realize the tremendous contribution from our associated professionals (the pharmacist, physician, chiropractor, and allied health in our building) and our patients.

Our patients have been great with the personal referrals (Thanks!) and the artwork given for display:A nice sculpture (from Danny)A fantastic mounted photo (from Paolo-displayed at the side. If you are interested in his work, I can put you in contact with him)